Last data update: Apr 22, 2024. (Total: 46599 publications since 2009)
Records 1-10 (of 10 Records) |
Query Trace: Naavaal S [original query] |
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The contribution of different permanent tooth types to untreated caries: Implications for public health surveillance and prevention
Griffin SO , Wei L , Naavaal S , Fleming E . J Am Dent Assoc 2021 152 (4) 269-276.e2 BACKGROUND: Untreated caries (UC), although highly prevalent, is largely preventable. Information on the contribution of different teeth to UC prevalence and severity could be helpful in evaluating UC surveillance protocols and the relative benefits of caries prevention interventions. METHODS: The authors combined data from 3 cycles (2011-2016) of the National Health and Nutrition Examination Survey for participants aged 6 through 11 years, 12 through 19 years, 20 through 34 years, 35 through 49 years, 50 through 64 years, 65 through 74 years, and 75 years and older. For each age group the authors calculated the contribution of successive permanent tooth types (for example, first molars and second molars) to UC prevalence and severity. RESULTS: UC prevalence and the percentage of prevalence detected by means of screening molars were, respectively, 5% and 95% among participants aged 6 through 11 years; 16% and 92% among participants aged 12 through 19 years; 29% and 86% among participants aged 20 through 34 years; 26% and 70% among participants aged 35 through 49 years; 21% and 48% among participants aged 50 through 64 years; 16% and 36% among participants aged 65 through 74 years; and 17% and 25% among participants 75 years and older. Among adults aged 50 years and older, no teeth appeared to capture a disproportionate share of UC prevalence. Molars accounted for 87%, 79%, and 56% of severity among participants aged 6 through 11 years, 12 through 19 years, and 20 through 34 years, respectively. After age 34 years, molars accounted for less than 50% of severity. CONCLUSIONS: Molars are the tooth type most susceptible to UC well into adulthood. PRACTICAL IMPLICATIONS: Molars could be used as sentinel teeth for surveillance of UC and adults could benefit from caries prevention that targets molars. |
COVID-19 Pandemic Impact on US Childhood Caries and Potential Mitigation.
Scherrer C , Naavaal S , Lin M , Griffin SO . J Dent Res 2022 101 (10) 220345221090183 Non-Hispanic Black (NHB) and Hispanic and low-income US children have a higher prevalence of untreated caries than their higher-income and non-Hispanic White (NHW) counterparts. Due to the COVID-19 pandemic, many dental offices and school sealant programs closed beginning March 2020. We examine the effect of reduced access to restorative care and sealants on the oral health of children from low-income households overall and by race/ethnicity and how increased sealant delivery in September 2022 could mitigate these effects. We used Markov chain Monte Carlo simulation to model COVID-19's impact on first permanent molar (1M) caries incidence and loss in quality of life (disability-adjusted life years [DALYs]) due to time lived with 1M untreated caries. Our model followed a cohort of children aged 7y in March 2020 until February 2024. Model inputs were primarily obtained from published studies and nationally representative data. Excess DALYs per 1,000 children attributable to reduced access to care during the pandemic were 1.48 overall and greater for Hispanic (2.07) and NHB (1.75) children than for NHW children (0.94). Excess incidence of 1M caries over 4y was 2.28percentage points overall and greater for Hispanic (2.63) and NHB (2.40) children than for NHW (1.96) children. Delivering sealants to 50% of eligible 1Ms in September 2022 would not completely mitigate COVID-19's health access impact: overall excess DALYs would decrease to 1.05, and absolute disparities in excess DALYs between NHW children and Hispanic and NHB children would remain but decrease by 0.38 and 0.33, respectively. Sealing 40% of eligible 1Ms, however, would bring overall 4-y caries incidence down to pre-COVID-19 levels and eliminate the differential effect of the pandemic on children from minority groups. The pandemic's negative impact on the oral health of children from low-income households and increased disparities could be partially mitigated with increased sealant delivery. |
Self-reported oral health status among adults age 40+ years with and without vision impairment: National Health Interview Survey, 2008
Crews JE , Chou CF , Naavaal S , Griffin S , Saaddine JB . Am J Ophthalmol 2019 210 184-191 PURPOSE: To examine self-reported oral health among adults age 40 years and older with and without vision impairment. DESIGN: Cross-sectional with a nationally representative sample. METHODS: We used publicly available data from the Oral Health Module, last administered in 2008 of the National Health Interview Survey. Outcome variables included fair/poor oral health status, mouth condition compared to others the same age, mouth problems (mouth sores, difficulty eating, dry mouth, bad breath and/or jaw pain), teeth problems (toothache; broken/missing fillings or teeth; loose, crooked or stained teeth; and/or bleeding gums) and lack of social participation. Using descriptive statistics and multivariate logistic regression, we examined the association (p<0.05) between vision impairment and oral health outcomes by age-group, sociodemographic, and other explanatory variables. RESULTS: Our study sample included 12,090 adults; 12.8% of adults aged 40-64 years reported vision impairment, and among them, 44.5% reported fair/poor oral health status and 47.2% reported any mouth problems. Among adults aged >/=65 years, 17.3% reported vision impairment, of whom 36.3% reported fair/poor oral health status, and 57.3 reported any mouth problems. There is a strong association between vision impairment and poorer oral health of adults; adults aged 40-64 years with vision impairment reported 90% to 150% greater odds of oral health problems, including fair/poor oral health status, mouth problems, and teeth problems, compared to people without vision impairment. CONCLUSIONS: Oral health disparities exist between adults with and without vision impairment. Targeted interventions are required to improve oral health in this vulnerable population. |
Impact of making dental care affordable on quality of life in adults aged 45 years and older
Naavaal S , Griffin SO , Jones JA . J Aging Health 2019 32 898264319857967 Objective: The objective of this study was to examine the associations between self-reported ability to afford dental care and quality of life in adults aged 45 years and older. Method: We used publicly available cross-sectional data from the 2008 National Health Interview Survey and its oral health supplement for 11,760 adults aged 45+ years. The increased probabilities of reporting dental problems attributable to an inability to afford dental care were estimated from multivariate models and combined with respective dental problem disability weights from the Global Burden of Disease to measure loss in quality of life. Results: Prevalence of reported inability to afford dental care, severe tooth loss, severe periodontitis, and untreated caries were 11.9%, 8.5%, 14.3%, and 37.9%, respectively. Inability to afford dental care was associated with an increase of 0.017 disability-adjusted life-years (DALYs) per person per year under base case and 0.020 DALYs under generous assumptions. Conclusion: Making dental care affordable could improve adult's (age 45 and above) quality of life at a reasonable cost. |
Variations in cigarette smoking and quit attempts by health insurance among US adults in 41 states and 2 jurisdictions, 2014
Naavaal S , Malarcher A , Xu X , Zhang L , Babb S . Public Health Rep 2018 133 (2) 33354917753120 OBJECTIVES: Information on the impact of health insurance on smoking and quit attempts at the state level is limited. We examined the state-specific prevalence of cigarette smoking and past-year quit attempts among adults aged 18-64 by health insurance and other individual- and state-level factors. METHODS: We used data from 41 states, the District of Columbia, and Puerto Rico, the jurisdictions that administered the Health Care Access module of the 2014 Behavioral Risk Factor Surveillance System. Data on quit attempts included current smokers with a past-year quit attempt and former smokers who quit during the past year. RESULTS: Overall, smoking prevalence ranged from 14.6% among those with private insurance to 34.7% among Medicaid enrollees, and past-year quit-attempt prevalence ranged from 66.4% among the uninsured to 71.5% among Medicaid enrollees. By insurance group, differences in the prevalence of state-specific past-year quit attempts ranged from 15 to 26 percentage points. Regardless of insurance type, people who were non-Hispanic white and had lower education levels were less likely to attempt quitting than were Hispanic people, non-Hispanic black people, and adults with more than a high school education. CONCLUSIONS: We found disparities in smoking and quit attempts by insurance status and state. Opportunities exist to increase access to cessation treatments through comprehensive state tobacco control programs and improved cessation insurance coverage, coupled with promotion of covered cessation treatments. |
Estimating the cost of school sealant programs with minimal data
Griffin SO , Jones K , Naavaal S , O'Connell JM , Demopoulos C , Arlotta D . J Public Health Dent 2017 78 (1) 17-24 OBJECTIVE: Develop methodology to estimate the annual cost of resources used by school sealant programs (SSPs) and demonstrate its use. METHODS: We used existing literature and expert opinion to identify SSP cost components and the most appropriate units for their measurement (e.g., per operator) and collection frequency (e.g., per day). For equipment and reusable instruments, costs were sufficiently homogenous across SSPs that we could provide default per unit cost estimates (2016 US$) that SSPs can use in lieu of collecting their own data. We also provide default costs for supply items such that SSPs can estimate total supply costs with program-specific information on sealant material used, as well as number of: sealant stations, operators, service delivery days, children screened/sealed, and number of teeth sealed. For the remaining three categories (labor, mileage, and administrative), costs varied substantially by SSP and required us to develop and pilot collection logs for program-specific data. RESULTS: The annual cost per sealant station ranged from $584 to $797 depending on program characteristics. For a hypothetical SSP that staffed each of two stations with two operators (hygienist and assistant) compensated at the national rate, hourly labor costs would equal $77.97. Assuming this SSP used disposable instruments, light-cured sealants and delivered sealants (3 per child) to 60 percent of the 3,390 children screened over 100 service days, infection control/supply costs per child would equal $5.30. CONCLUSION: This methodology allows SSPs to estimate costs with minimal data collection and time. |
School-based dental sealant programs prevent cavities and are cost-effective
Griffin S , Naavaal S , Scherrer C , Griffin PM , Harris K , Chattopadhyay S . Health Aff (Millwood) 2016 35 (12) 2233-2240 Untreated cavities can have far-reaching negative consequences for people's ability to eat, speak, and learn. By adolescence, 27 percent of low-income children in the United States will have untreated cavities. School-based sealant programs typically provide dental sealants (a protective coating that adheres to the surface of molars) at little or no cost to students attending schools in areas with low socioeconomic status. These programs have been shown to increase the number of students receiving sealants and to prevent cavities. We analyzed the cost-effectiveness of school sealant programs using data (from school programs in fourteen states between 2013 and 2014) on children's cavity risk, including the effects of untreated cavities on a child's quality of life. We found that providing sealants in school programs to 1,000 children would prevent 485 fillings and 1.59 disability-adjusted life-years. School-based sealant programs saved society money and remained cost-effective across a wide range of reasonable values. |
Evaluation of school-based dental sealant programs: An updated Community Guide Systematic Economic Review
Griffin SO , Naavaal S , Scherrer C , Patel M , Chattopadhyay S . Am J Prev Med 2016 52 (3) 407-415 CONTEXT: A recently updated Community Guide systematic review of the effectiveness of school sealant programs (SSPs) still found strong evidence that SSPs reduced dental caries among schoolchildren. This follow-up systematic review updates SSP cost and benefit information from the original 2002 review. EVIDENCE ACQUISITION: Using Community Guide economic review methods, the authors searched the literature from January 2000 to November 20, 2014. The final body of evidence included 14 studies-ten from the current search and four with cost information from the 2002 review. Nine studies had information on SSP costs; six on sealant benefit (averted treatment costs and productivity losses); four on SSP net cost (cost minus benefit); and three on net cost to Medicaid of clinically delivered sealants. The authors imputed productivity losses and discounted costs/outcomes when this information was missing. The analysis, conducted in 2015, reported all values in 2014 U.S. dollars. EVIDENCE SYNTHESIS: The median one-time SSP cost per tooth sealed was $11.64. Labor accounted for two thirds of costs, and time to provide sealants was a major cost driver. The median annual economic benefit was $6.29, suggesting that over 4 years the SSP benefit ($23.37 at a 3% discount rate) would exceed costs by $11.73 per sealed tooth. In addition, two of four economic models and all three analyses of Medicaid claims data found that SSP benefit to society exceeded SSP cost. CONCLUSIONS: Recent evidence indicates the benefits of SSPs exceed their costs when SSPs target schools attended by a large number of high-risk children. |
Prevalence of past-year dental visit among US adults, 1999-2010: Comparison of trends and estimates between the Behavioral Risk Factor Surveillance System and three national surveys
Lin M , Li CH , Wei L , Naavaal S , Kolavic Gray S , Manz MC , Barker L . J Public Health Dent 2016 77 (2) 105-114 OBJECTIVES: To compare estimated prevalence of past-year dental visit (PPYDV) among US adults aged ≥18 years from the Behavioral Risk Factor Surveillance System (BRFSS) to estimates from the Medical Expenditure Panel Survey (MEPS), National Health Interview Survey (NHIS), and National Health and Nutrition Examination Survey (NHANES). METHODS: We estimated PPYDV adjusted for covariates (age, race/ethnicity, education level, poverty status, edentulism) using BRFSS, MEPS, and NHIS 1999-2010, and NHANES 1999-2004. We tested trend in overall PPYDV for BRFSS, MEPS, and NHIS from 1999-2010. For 2002 and 2010, we calculated absolute differences (AD) and 95% confidence intervals (CI) in PPYDV between BRFSS and each of the other surveys overall and among subpopulations defined by covariates. We pooled NHANES 1999-2004 data for comparison with BRFSS 2002. RESULTS: From 1999 to 2010, BRFSS (68.5% vs. 67.5%), MEPS (43.5% vs. 39.7%), and NHIS (63.3% vs. 59.7%) showed small but significant decreases in overall PPYDV. In 2002, estimates for overall PPYDV were highest for BRFSS (70.0%) and lowest for MEPS (43.9%) with estimates for NHIS (61.5%) and NHANES (1999-2004: 58.1%) in between; the largest AD (26.2%, 95% CI: 25.0%-27.3%) was between BRFSS and MEPS. ADs were consistent in 2002 and 2010, overall and by covariates, except among edentate persons, where PPYDV estimates from BRFSS and NHIS were similar. CONCLUSIONS: Estimates of PPYDV from BRFSS were notably higher than estimates from MEPS, NHIS, or NHANES except among the edentate. Trends in PPYDV over time, however, were consistent across all surveys. |
The effect of health and dental insurance on US children's dental care utilization for urgent and non-urgent dental problems - 2008
Naavaal S , Barker LK , Griffin SO . J Public Health Dent 2016 77 (1) 54-62 OBJECTIVE: We examined the association between utilization of care for a dental problem (utilization-DP) and parent-reported dental problem (DP) urgency among children with DP by type of health care insurance coverage. METHODS: We used weighted 2008 National Health Interview Survey data from 2,834 children, aged 2-17 years with at least one DP within the 6 months preceding survey. Explanatory variables were selected based on Andersen's model of healthcare utilization. Need was considered urgent if DP included toothache, bleeding gums, broken or missing teeth, broken or missing filling, or decayed teeth and otherwise as non-urgent. The primary enabling variable, insurance, had four categories: none, private health no dental coverage (PHND), private health and dental (PHD), or Medicaid/State Children's Health Insurance Program (SCHIP). Predisposing variables included sociodemographic characteristics. We used bivariate and multivariate analyses to identify explanatory variables' association with utilization-DP. Using logistic regression, we obtained adjusted estimates of utilization-DP by urgency for each insurance category. RESULTS: In bivariate analyses, utilization-DP was associated with both insurance and urgency. In multivariate analyses, the difference in percent utilizing care for an urgent versus non-urgent DP among children covered by Medicaid/SCHIP was 32 percentage points; PHD, 25 percentage points; PHND, 12 percentage points; and no insurance, 14 percentage points. The difference in utilization by DP urgency was higher for children with Medicaid/SCHIP compared with either PHND or uninsured children. CONCLUSION: Expansion of Medicaid/SCHIP may permit children to receive care for urgent DPs who otherwise may not, due to lack of dental insurance. |
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